It’s Thursday. “Who got the Pulse, baby? Who got the only sweetest thing in the world?”

WHAT’S THE DEAL? -- A day after Senate leaders announced a breakthrough on the thorny issue of the public option, it was still unclear Wednesday whether the tentative pact had in fact broken the deadlock. It was hard to find anyone who knew the details of the agreement and even harder to find someone willing to sign off on it. Because CBO is busy estimating the deal’s costs, in-the-know Democrats didn’t share the details with their colleagues. Dick Durbin, the Senate’s No. 2 Democrat, emerged from an afternoon caucus meeting and said he didn’t know how it would work. Most senators have the same gist as the rest of us, the agreement replaces a public option with some kind of national insurance plan offered by private non-profits and allows people to begin buying Medicare coverage at age 55. A sampling of mod reaction: Blanche Lincoln seems to like the government-private sector balance; Ben Nelson’s waiting on the CBO scores and Lieberman’s “encouraged.” Hospitals still hate the buy-in and now you can add insurers to that list. HCAN loves the buy-in, but wants a public option for people whose hair is still producing pigment. And even House progressives refrained from dumping on the plan. Rep. Anthony Weiner, of give-us-a-vote-on-single-payer fame, lauded the Medicare expansion as a triumph. With the previews over, everyone will likely have to wait at least a few more days for CBO’s feature presentation.

WAITING FOR GO… CBO – NYT’s David Herszenhorn and Robert Pear: “Senate Democrats said on Wednesday that they were not sure exactly what was in a deal that the majority leader said would surmount a disagreement over a proposed government-run health plan. But they voiced guarded optimism that it would ultimately help them pass major health care legislation. … In the floor fight over the health care proposal, now 10 days old, Senate Republicans continued their efforts to torpedo the bill, citing polls that they said showed mounting public opposition. And Democrats, rather than trying to perfect the bill, seemed intent primarily on just keeping it alive. ‘Any big agreement is progress,’ said Senator Bob Casey, Democrat of Pennsylvania. ‘Even if we do not know any of the details.’ The majority leader, Harry Reid of Nevada, on Wednesday sent the tentative proposal to the Congressional Budget Office for cost analysis, and Democrats acknowledged that the bill’s fate hinged on the results. In that sense, the deal was less a comprehensive accord than a decision to keep the process moving.”

OBAMA’S ENTHUSIASTIC: "The Senate made critical progress last night with a creative new framework that I believe will help pave the way for final passage and a historic achievement on behalf of the American people,” Obama said. “I support this effort, especially since it's aimed at increasing choice and competition and lowering cost. I want to thank all of you for sticking with it, for all those late nights. With so much at stake, this is well worth all of our efforts.”

DOCS AND HOSPITALS ARE NOT, reports WaPo’s Shailagh Murray and Lori Montgomery: “Lawmakers remained wary of the objections of hospital and doctor groups, which have considerable influence on Capitol Hill. The groups believe their members could be the big losers under the proposal to allow people as young as 55 to buy into Medicare, because the program pays providers at much lower rates than private insurers, and because older Americans are the greatest consumers of health-care services. Hospital representatives said the idea also would violate a deal they reached with the White House this year to give up $155 billion in Medicare payments over the next decade. The concession helped to lower the cost of a health-care package that promised hospitals a pool of at least 30 million newly insured customers. … American Medical Association President J. James Rohack warned Wednesday on his blog that expanding Medicare would jeopardize access to physician services not only for near-retirees, but for millions of people older than 65 who already are covered by the federal plan.”

** To fix health care, we need to cover everyone. We can only afford to cover everyone by fixing health care. Kaiser Permanente believes both are needed. Go to http://www.kp.org/reform for more. **

LIBERALS' PUBLIC OPTION DREAM FADING, reports POLITICO’s Carrie Budoff Brown: “The idea of an immediate plan to offer government insurance for all effectively died in the Senate this week of a thousand cuts: a filibuster threat from Sen. Joe Lieberman (I-Conn.), a bright line drawn by Sen. Ben Nelson (D-Neb.) over abortion, a recognition that short-circuiting a filibuster was unworkable and a batch of bad unemployment figures that made Democrats anxious to move off health care by the State of the Union. Also in the past month, some progressive health policy thinkers began to openly question whether the public option was really worth all the fuss, at least in the form envisioned by Congress. Rather than salvage the public option in a weakened form, Democrats looked for an alternative. And some well-timed advice from Howard Dean, the former Democratic National Committee chairman, helped to break the stalemate.”

EXCLUSIVE -- OUT TODAY: A report by the American Association for Justice that shows state tort reforms have been a financial boon to insurers while providing no relief to docs and patients. Report here.

BUY-IN MIGHT BE TOO PRICEY, reports WSJ’s Janet Adamy: “Millions more Americans could get access to Medicare under the latest health proposal by Senate Democrats. But the program may not be cheap enough to entice some of them to sign up. … The Medicare plan could be good news for some in the 55-64 bracket who currently don't have an easy way to get coverage. Those who must buy coverage on their own often face high premiums or are shut out entirely because of pre-existing conditions. … Senate Democrats have yet to release a formal plan and haven't said how much it would cost younger people to buy into Medicare. While these people are likely to receive subsidized coverage, their payments would be far greater than those over 65, who pay $100 a month or more for coverage, depending on their income. Based on data from the Congressional Budget Office, a report by the seniors' lobby AARP estimated that an earlier proposal to expand Medicare to a narrower group would cost participants $634 a month.”

WHAT IT MEANS FOR CONSUMERS – WaPo’s Alec MacGillis: “The Senate bill always sought to have people choose plans from separate state-based exchanges, and skeptics worried that many states would offer poor oversight. Laying two national plans over those state-based marketplaces is designed to guarantee some well-regulated options for consumers everywhere. … But other health policy experts are doubtful about what additional benefit the national plans would offer. As it is, they note, the House bill proposes a nationwide marketplace of plans, though insurers would not have to offer every plan in every state. Aside from the 50-state reach, skeptics say, it is unclear how the new national plans would differ from the plans that private insurers would already be offering. The nonprofit status of the proposed plans would not necessarily guarantee low costs -- many private insurers today are technically nonprofit. Nor would the plans' nationwide scope and oversight by the OPM guarantee better rates -- premiums for the federal employee benefit plans, which serve 8 million people (including the members of Congress), increased by nearly 9 percent this year.”

GOP ATTACKS AARP, reports Inside Health Policy’s John Wilkerson: “Medicare Advantage beneficiaries who would lose that benefit under the House health reform bill would likely pick up supplemental Medigap coverage to compensate, which House Republicans say would benefit AARP because the group has a strong position in the Medigap market and supplemental insurance is the only product not subject to stricter medical loss ratios in the bill. Republican lawmakers are asking whether AARP was given a ‘sweetheart’ deal in return for supporting health reform. A House Energy and Commerce Committee Democratic aide brushed aside the insinuations as ridiculous, and AARP said any health-reform effect to Medigap has not factored into health reform discussions. Up to now, AARP has not issued an official endorsement of the Senate health reform bill as it continues to urge lawmakers to close the Part D donut hole. AARP's potential benefit from MA cuts was raised by GOP members during a Dec. 8 Energy and Commerce health subcommittee hearing on rising drug prices. Democrats invited AARP to testified about a report it commissioned that found the cost of wholesale brand-name drugs increased 9.3 percent last year, even though inflation was negative during the same period. But Republicans used the hearing to go after AARP, and their main target was the Medigap insurance plans that bear the AARP logo.” $5

ETHICS COMPLAINT AGAINST MCCAIN, reports HuffPo’s Arthur Delaney: “Sen. John McCain (R-Ariz.) broke Senate rules when he recorded a robocall touting his amendment to the health care bill, according to a complaint filed with the Senate Ethics Committee by watchdog group Citizens for Responsibility and Ethics in Washington. The National Republican Senatorial Committee paid for the call, which targeted the constituents of swing senators in five states and attacked the current health care reform bill for ‘cutting $500 billion in vital Medicare coverage for our seniors.’ The call urged constituents to sign a petition encouraging the senators to support McCain's amendment. In its complaint, CREW cites Senate Rule 38, which prohibits senators from using private donations to support official Senate activities. ‘The NRSC is clearly paying for it,’ CREW director Melanie Sloan told the Huffington Post, ‘but it is McCain lobbying for his own bill.’ … NRSC spokesman Brian Walsh defended the call and referred to CREW as a ‘left-wing front group’ in a statement.”

PULSE OP-ED:

-- NYT Editorial: “Ten Democratic senators are calling for abandoning the much-maligned ‘public option’ — a government-run health insurance plan to compete with private insurers — and replacing it with two programs that might achieve the same goal of expanding Americans’ choices and providing some competition. We won’t know if this compromise does that until the Congressional Budget Office has evaluated it. But we admire the senators’ desire to try to move reform legislation forward. … At this point, even the 10 Senate negotiators have not fully agreed to all elements of the deal. They have simply agreed to have the budget office evaluate it. Until that is in, it is impossible to know whether this nonpublic option is an acceptable alternative.”

--WaPo Editorial: “The only thing more unsettling than watching legislative sausage being made is watching it being made on the fly. The 11th-hour ‘compromise’ on health-care reform and the public option supposedly includes an expansion of Medicare to let people ages 55 to 64 buy into the program. This is an idea dating to at least the Clinton administration, and Senate Finance Committee Chairman Max Baucus (D-Mont.) originally proposed allowing the buy-in as a temporary measure before the new insurance exchanges get underway. However, the last-minute introduction of this idea within the broader context of health reform raises numerous questions -- not least of which is whether this proposal is a far more dramatic step toward a single-payer system than lawmakers on either side realize. … Once 55-year-olds are in, they are not likely to be kicked out, and the pressure will be on to expand the program to make more people eligible. The irony of this late-breaking Medicare proposal is that it could be a bigger step toward a single-payer system than the milquetoast public option plans rejected by Senate moderates as too disruptive of the private market.”

--WSJ Editorial: “Olympia Snowe delivered a very good speech on health care shortly before Thanksgiving, not that the press corps noticed. With Majority Leader Harry Reid's announcement this week of a double-secret bargain that Democrats hope will squeeze ObamaCare through the Senate—after nine whole days of debate so far in the world's greatest deliberative body—the Maine Republican's words seem more pertinent than ever. … We've sometimes disagreed with Mrs. Snowe, especially on taxes, but on this one we couldn't put it better than she did in November: ‘Every line and every word in this 2,000-page document matters. . . . When it comes to the subject at hand, the most consequential health-care legislation in the history of our country and reordering $33 trillion in health-care spending over the coming decade, surely, we can and must do better.’ The ‘right side of history’ on this bill is to force Democrats to make it genuinely bipartisan.”

EDITED BY MICHAEL FALCONE

** We need to cover everyone in America so that we can fix care. We need to fix care so we can afford to cover everyone in America. Care reform and insurance reform need to be a package, interwoven and synched up. See http://kp.org/reform and read the Huffington Post for Kaiser Permanente thoughts on care reform. **

Reader's Comments (3)

HEALTH CARE REFORM MONEY IS IN CONTROL IF THE MULTA-MILLIONS BEING SPENT TO DEFEAT ?? YOU-- PEOPLE WHO HAVE GOOD HEALTH CARE{I LIKE WHAT I HAVE} NEED TO LOOK AT THE TREND.INCREASED PREMIUMS AT THE CURRENT RATE YOUR PLAN WILL TRIPLE IN THE NEXT 6 YEARS CAN YOU AFFORD THAT??? REFORM EXPENSIVE NO REFORM COULD BE A DIASTER IF IT GOES AS FAST AS IN THE LAST 8 YEARS NO ONE CAN AFFORD IT.THEOLDMANSAYS DON'T LISTEN YOU MUST CHECK IT OUT FOR YOURSELF FACTS,FACTS AND THE FUTURE.

HEALTH CARE REFORM MONEY IS IN CONTROL IF THE MULTA-MILLIONS BEING SPENT TO DEFEAT ?? YOU-- PEOPLE WHO HAVE GOOD HEALTH CARE{I LIKE WHAT I HAVE} NEED TO LOOK AT THE TREND.INCREASED PREMIUMS AT THE CURRENT RATE YOUR PLAN WILL TRIPLE IN THE NEXT 6 YEARS CAN YOU AFFORD THAT??? REFORM EXPENSIVE NO REFORM COULD BE A DIASTER IF IT GOES AS FAST AS IN THE LAST 8 YEARS NO ONE CAN AFFORD IT.THEOLDMANSAYS DON'T LISTEN YOU MUST CHECK IT OUT FOR YOURSELF FACTS,FACTS AND THE FUTURE.

HEALTH CARE REFORM MONEY IS IN CONTROL IF THE MULTA-MILLIONS BEING SPENT TO DEFEAT ?? YOU-- PEOPLE WHO HAVE GOOD HEALTH CARE{I LIKE WHAT I HAVE} NEED TO LOOK AT THE TREND.INCREASED PREMIUMS AT THE CURRENT RATE YOUR PLAN WILL TRIPLE IN THE NEXT 6 YEARS CAN YOU AFFORD THAT??? REFORM EXPENSIVE NO REFORM COULD BE A DIASTER IF IT GOES AS FAST AS IN THE LAST 8 YEARS NO ONE CAN AFFORD IT.THEOLDMANSAYS DON'T LISTEN YOU MUST CHECK IT OUT FOR YOURSELF FACTS,FACTS AND THE FUTURE.